Urinary Incontinence and Indwelling Urinary Catheters in Acutely Admitted Elderly Patients: Relationship With Mortality, Institutionalization, and Functional Decline

OBJECTIVES: To study differences in functional status at admission in acutely hospitalized elderly patients with urinary incontinence, a catheter, or without a catheter or incontinence (controls) and to determine whether incontinence or a catheter are independent risk factors for death, institutionalization, or functional decline.

DESIGN: Prospective cohort study conducted between 2006 and 2008 with a 12-month follow-up.

SETTING: Eleven medical wards of 2 university teaching hospitals and 1 teaching hospital in The Netherlands.

PARTICIPANTS: Participants included 639 patients who were 65 years and older, acutely hospitalized for more than 48 hours.

MEASUREMENTS: Baseline characteristics, functional status, presence of urinary incontinence or catheter, length of hospital stay, mortality, institutionalization, and functional decline during admission and 3 and 12 months after admission were collected. Regression analyses were done to study a possible relationship between incontinence, catheter use, and adverse outcomes at 3 and 12 months.

RESULTS: Of all patients, 20.7% presented with incontinence, 23.3% presented with a catheter, and 56.0% were controls. Patients with a catheter scored worst on all baseline characteristics. A catheter was an independent risk factor for mortality at 3 months (odds ratio [OR] = 1.73, 95% confidence interval [CI] 1.10-2.70), for institutionalization at 12 months (OR = 4.03, 95% CI 1.67-9.75), and for functional decline at 3 (OR = 2.17, 95% CI 1.32-3.54) and 12 months (OR = 3.37, 95% CI 1.81-6.25). Incontinence was an independent risk factor for functional decline at 3 months (OR = 1.84, 95% CI 1.11-3.04).

CONCLUSION: There is an association between presence of a catheter, urinary incontinence, and development of adverse outcomes in hospitalized older patients.